The Impact of changing service models of the identity of learning disability nurses

My journey into learning disability nursing started at an early age when I worked

voluntarily with children who had complex disabilities and were staying in the respite

care environment, where I volunteered. My passion for working with people with

learning disabilities continued as I undertook nurse ‘training’ in a large long-stay

hospital and faced challenges on a daily basis to the way I felt care should be

delivered. Over the years I worked with many nurses who, like me, were constrained

by an environment of routine and order, one which often disempowered both the

nurses and those that lived in that environment. However, I was also supported in

this environment, feeling part of a ‘community’ and feeling privileged to share the

day-to-day lives of people with learning disabilities. I began my nurse training in the

early 1980s at a time when there had been a major challenge to the role of the

learning disability nurse from the Briggs report (1972) and the Jay Report (1979).

The Briggs report had suggested a new professional grouping and Jay had

suggested replacing nurses with workers who held a social care-based qualification.

Each decade post Jay brought with it a challenge to the role of the learning disability

nurse. A letter from the Chief Nursing Officer (CNO) in 1985 reinforced the commitment to maintaining the role and status of the learning disability nurse

(Mitchell, 2000). The 1990s also brought with it a change in the emphasis in role of

the learning disability nurse, the Cullen report (1991) suggested a greater emphasis

for learning disability nurses on the health rather than social care needs of those with

learning disabilities – a move towards health – and this has been further supported by

a number of reports as the focus on the role of the nurse has re-emerged in health.

This focus has been reinforced by a number of reports that have acknowledged the

health needs of people with learning disabilities who have moved from institutions

and into community-based living.

 

With this background, learning disability nurses have been debating their role within

the nursing profession since (Mitchell, 2003). Some 30 years later, in 2001, the

Government produced its White Paper Valuing People First (DH, 2001) where there

is little mention of specific services, but the notion of inclusion and the use of generic

services is clear and part of the guiding principles of this White Paper.

Although still a discrete branch of nursing, the debate around the future of the

learning disability nurse still rumbles on. A wide range of service provider agencies,

and inclusion being the key principle for people with learning disabilities in society,

has left some doubt over the future role of the learning disability nurse. The impact of

this debate is not only upon service provision but also on the future education of

learning disability nurses. Mitchell’s (1998; 2000; 2002a; 2003) work has examined

the link between social policy, service provision and education. This study is located

within this context and develops further the work of Mitchell to examine current

Government policy (Post Jay Report) to include key policy documents and reports –

Continuing the Commitment (DH, 1996) Signposts for Success (DH, 1998); Valuing

People (DH, 2001); The Health & Social care Act (DH, 2003); Choosing Health (DH,

2004); Our Health, Our Care, Our Say (DH, 2006), and the potential impact on

service provision and the future of learning disability nursing and education. The

narratives of learning disability nurses will contribute to an

understanding of the impact of said policies upon the lives and careers of learning

disability nurses in England in the past 30 years.